Weight Loss Surgery

Sleeve Gastrectomy

Schème du mode d'action de l'intervention Sleeve gastrectomie
The food will pass very quickly in the small intestine.

 

Sleeve Sleeve acts by several mechanisms which join :

  • A restriction (like gastroplasty).
  • A reduction in the rate of ghrelin, the hormone of hunger, which involves a disinterest for food.

Sleeve gastrectomie

  • Sleeve is a complex intervention, with a 4 days hospitalization.
  • Sleeve is a recent surgical procedure, its long-term results (more than 5 years) are unknown.
    Weight loss is usually about 4 kgs per month, during the first 6 months, then from 2 to 4 kgs per month.
    This procedure was initially proposed among patients having very high BMI (>50), and at which, for technical reasons, a bypass can prove to be dangerous.
    The sleeve enables them to lose approximately 40 kgs before passing, if the weight loss stagnates, to a bypass, which becomes easier to realize.

     

    Currently, some teams propose this intervention like replacement of the gastroplasty for the following reasons:

    • It involves a fast feeling of satiety, like the gastroplasty.
    • It does not require the installation of a foreign body (gastric band).
    • Vomiting is less frequent than with the gastroplasty.
    • It decreases the rate of ghrelin, and thus the feeling of hunger, like the bypass.

     

    According to the very rare scientific studies available, the average weight loss is of 50% of the weight excess in one year, which is an intermediate result between gastroplasty and bypass.

  • Denutrition and vitamin deficiencies are rare.
    No oral supplementation is necessary. A biological assessment after a weight loss from 25 to 30 kgs is carried out. Sometimes it shows small vitamin deficits which are easily made up by oral way.
  • Sleeve is not réversible.However, in a certain number of cases, the tube is likely to dilate at the end of 3 to 4 years, and does not have any more any effectiveness.
  • Dietary habits must be modified.
    3 meals and possibly 2 collations.
  • Vomiting is rare.
  • A regular follow-up by a multi disciplinary team is necessary.2 Blood tests are necessary the first year, then 1 blood test per annum, to seek a vitamin deficit.

The day before the procedure

  • Hospitalisation at 5 PM.
  • You can eat normally.

D Day

  • No food, no drink since midnight.
  • The procedure lasts approximately 2 hours, it requires a general anesthesia and is achieved by coelioscopy.
  • After the procedure, you will spend a few hours in recovery room, before you return in your room.
  • Drugs against pain will be managed to you by venous way.
  • The evening : emply stomach.

D1

  • No food, no drink, you must stay in bed.
  • Drugs against pain will be managed to you by venous way.
  • A kinesitherapist will come to mobilize you in your bed.

D2

  • A kinesitherapist will help you to raise you and will make you walk.
  • A X ray of your new digestive circuit will be done.
  • After midday and the evening, you will be able to drink water.

D3

  • A kinesitherapist will help you to raise and will make you walk.
  • The morning, you will be able to drink a tea, at midday and the evening, a soup.

D4

  • You will be able to leave the establishment at 11 am.
  • A presciption will be given to you for vitamins and scar cares, and a seak leave from one to three weeks, according to your job painfulness.

Sars

You have usually 4 or 5 small scars on the abdomen, which are closed by fasten, of wire (which it is necessary to make withdraw) or of resorbable wire (which only leave all).

 

The bandages can be changed one day out of 2.
I advise you to use tight bandages, you will be able to take showers easyly.

 

You can make withdraw wire or fasten between D12 and D15.
It is not necessary to put bandages.
You can take showers, clean the scars with household soap, without rubbing.
Still await ten day before taking baths.

Food

The intervention is still very close, the small stomach is not well healed.

 

It is essential not "to force" the system, which could compromise its effectiveness in the following months.

 

I propose the following procedure : the 5 days rule.
Your hospitalization lasted 5 days.
At your exit, you must eat liquid for 5 days (water, tea, soup...)
Then you must eat crushed food for 5 days.
Then you can eat everything, while chewing food well. I advise you to crush meat for one month.

 

No stress, there is no reason food does not pass.

The first month

The first month enables you to be accustomed to your new digestive tract.

 

Eat very slowly, because you should not fill the small gastric pouch, which is healing.

 

After the first month

Eat in calm at regular hours.

  • Split your food catches in three meals (and, possibly, one or two collations).
  • Vary your food.
  • Eat only small pieces.
  • You must chew lengthily, and swallow several times.
  • Take time to appreciate your meal. Do not forget that digestion starts in your mouth.
  • Drink the least possible during your meals..
  • With the appearance of a feeling of satiety, imperatively cease eating.
  • Supervise your teeth

One coffee spoon moreover could make you vomit. You have only a mini gastric pouch, do not forget it.

If you vomit, Try to understand why :

  • You eat too much.
  • You eat too quickly.
  • You eat too large pieces.
  • You do not chew enough.
  • You swallow too quickly.

Beetween meals

Avoid sweetened drinks and, in theory, aerated beverages.
Often Drink apart from the meals, by small quantity, even without thirst.

 

Take again a regular physical activity, leisures and endurance. The simplest regular physical activity is walking : walk of a good step but at your own rythm, the ideal being 3 times 30 to 40 minutes per week.
A kinesitherapist may help you. After the first month, you can practise any sport activity.

 

Respect sufficient hours of sleep.
Possibly make you accompany on the level '' management of stress ''.

A regular follow up by your general practitionar is important.

In addition to your daily contribution in vitamins and trace elements, your doctor will incite you to optimize your food in the direction of a better contribution out of Iron, Calcium,(possibly after a biology of these elements).

 

You must be also careful with a possible proteinic denutrition. If you do not eat sufficient proteins, you will lose on your muscular masses, whereas it would be preferable to lose on your fat or water of your body. In worst case, you can undergo a protéin denutrition, with fall of immunizing defenses and a tiredness, an anaemia, a increased sensitivity to infections.

 

Eat well and enjoy your life !

Complications of sleeve gastrectomy are fortunately rare, but are important to know.

 

It is essential to evaluate the operational risk compared to the anticipated profits of sleeve gastrectomy, before taking the decision to have an operation.

 

This risk is related to your medical history (cardiac, pulmonary…) and with the procedure (surgery and anaesthesia).

 

First week

Operational complications are possible, they can bring to stop the procedure : perforation, haemorrhage, impossibility of intubation of the trachea.

 

A section of the stomach is made, with the risk of fistulisation, requiring a new intervention, and of haemorrhage.
They are serious complications, with a vital pronostic.

 

The phlebitis and pulmonary embolisms are prevented by the use of anticoagulant drugs with low dose and the port of special socks.

First month

An infection on the level of a small scar is possible.

After the first month

Nutritional deficiencies are possible :

Particularly Calcium, iron, folates and B12 vitamin.
They can be responsible for an anaemia.
They are avoided by an additional contribution by oral way and regular blood analysis.

 

Gastric ulcer :

It is avoided by specific drugs.

 

Anastomosis stenosis :

It is revealed by brutal vomiting.
It requires radiographies and a scanner to make the diagnosis.

Later on

The long-term results are not actually known.
The result on the weight loss at 5 years is intermediate between the bypass and the gastroplasty: approximately 60% of the excess of weight, but that must be confi rmed by scientific studies.

 

It is possible that the tube dilates and had no utility after 3 years or more.

 

Failures of Sleeve are possible, the causes are the same as gastroplasty and bypass :

 

No medical monitoring by an experienced team.
No modifications of the food behavior.
No resumption of a regular physical-activity.

 

These failures stress the importance of the assessment before the intervention, the good knowledge of the food constraints and the anticipated results of sleeve.

Last update 19 August 2015